Low-dose in vivo protection and neutralization across SARS-CoV-2 variants by monoclonal antibody combinations.
Dussupt, V., Sankhala, R.S., Mendez-Rivera, L., Townsley, S.M., Schmidt, F., Wieczorek, L., Lal, K.G., Donofrio, G.C., Tran, U., Jackson, N.D., Zaky, W.I., Zemil, M., Tritsch, S.R., Chen, W.H., Martinez, E.J., Ahmed, A., Choe, M., Chang, W.C., Hajduczki, A., Jian, N., Peterson, C.E., Rees, P.A., Rutkowska, M., Slike, B.M., Selverian, C.N., Swafford, I., Teng, I.T., Thomas, P.V., Zhou, T., Smith, C.J., Currier, J.R., Kwong, P.D., Rolland, M., Davidson, E., Doranz, B.J., Mores, C.N., Hatziioannou, T., Reiley, W.W., Bieniasz, P.D., Paquin-Proulx, D., Gromowski, G.D., Polonis, V.R., Michael, N.L., Modjarrad, K., Joyce, M.G., Krebs, S.J.(2021) Nat Immunol 22: 1503-1514
- PubMed: 34716452 
- DOI: https://doi.org/10.1038/s41590-021-01068-z
- Primary Citation of Related Structures:  
7N4I, 7N4J, 7N4L, 7N4M - PubMed Abstract: 
Prevention of viral escape and increased coverage against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern require therapeutic monoclonal antibodies (mAbs) targeting multiple sites of vulnerability on the coronavirus spike glycoprotein. Here we identify several potent neutralizing antibodies directed against either the N-terminal domain (NTD) or the receptor-binding domain (RBD) of the spike protein. Administered in combinations, these mAbs provided low-dose protection against SARS-CoV-2 infection in the K18-human angiotensin-converting enzyme 2 mouse model, using both neutralization and Fc effector antibody functions. The RBD mAb WRAIR-2125, which targets residue F486 through a unique heavy-chain and light-chain pairing, demonstrated potent neutralizing activity against all major SARS-CoV-2 variants of concern. In combination with NTD and other RBD mAbs, WRAIR-2125 also prevented viral escape. These data demonstrate that NTD/RBD mAb combinations confer potent protection, likely leveraging complementary mechanisms of viral inactivation and clearance.
Organizational Affiliation: 
Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA.